Search

The aim of this paper is to shed light on the figure of Francesco Maria Fiorentini, a 17th-century physician from Lucca (Tuscany, Italy) and member of the Iatromechanical School, who distinguished himself for his role during the plague and the typhus epidemics that spread throughout Italy in the first half of that century. His work must be contextualized in a precise historical moment, which marked the gradual transition of Western medicine from the archaism of Galenic doctrine to that of the Iatromechanical School, when the foundations started to be laid for an experimental type of medicine that based its assumptions on the direct observation of phenomena concerning the human body. In this work, we mainly focus on the medical biography of Fiorentini and on the reasons why he enjoyed great social prestige among the most prominent figures of his time. However, Fiorentini should also be remembered as a multifaceted scholar, as evidenced by his numerous writings, which underline his erudition in disparate fields of knowledge., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

An editorial is presented which introduces a special issue of Communication and Medicine (C&M) that is a collection of written-up versions of presentations from the 19th COMET (Communication, Medicine, and Ethics) conference, highlighting various topics ranging from dental professionals' role perceptions to public and social media narratives about vaccination. It also discusses the longstanding relationship between the COMET conference and C&M journal.

Paolo Mascagni (Pisa 1755-Siena 1815) was one of the major members of the cultural and scientific community in Tuscany in the XIX century. After initial interest in geological investigations, he successfully turned his attention to medical sciences. In 1801, Mascagni was appointed as Professor of Anatomy at the University of Pisa, with additional charge of Lecturer at the Hospital of Santa Maria Nuova in Florence. Within his teaching activity he also designed several anatomic drawings which were employed for wax models of human organs. Such models, which are still visible in the La Specola museum in Florence, were so appreciated for their accuracy, that the curators of the Viennese Josephinum requested copies of them for teaching purposes. The current paper explores the relationship between Mascagni and the Josephinum, and aims to point out the importance of the Italian contribution to the education of the students of the Viennese Medical University.

Due to changes in social and health needs, the reorganisation of health systems towards community and primary care requires the redefinition of different professional identities and practices. This paper focuses on the specialists in the system: the physicians who work in outpatient services (local health authorities, hospitals, and other institutions) not as dependents but under private contract. This doctor has to balance the professional culture (in terms of autonomy and indipendence of judgment) with the bureaucratic logic that rules the organisations for which he or she works. Our research objective was to identify the identity variables characterising the specialist doctor ("ideal profile") and analyse the extent to which these differed from the doctor's actual identity ("actual profile"). From a methodological perspective, 1) we used a consensus method approach to identify the variables that define the specialist's identity, and 2) using a national web survey, we checked the distance between such characteristics and these professionals' actual identities. Involving different experts in the field of primary care, we identified 27 identity variables that appear to be at the core of specialist expertise. We then asked a representative sample of specialists to indicate how important and feasible these variables were in their work contexts and identified four main factors characterising their identities. The results demonstrate that, among experts, there is a clear perception of the need to build an identity that is linked to integration and to adopt a heuristic approach through teamwork and networking. However, this differs considerably from the logic of the specialists working in outpatient services: What emerges is the perceived difficulty of operational translation due to organisational problems or, otherwise, the constitutive elements of professional identity., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

We quantified Italian researchers’ share of the scientific papers published in peer-reviewed medical Journals in the field of neurology in 2003 and 2004. The findings show that Italian researchers’ gained an overall 7% share of peer-reviewed articles. This percentage places Italy in fourth place immediately after the United States, Grat Britain and Germany. [ABSTRACT FROM AUTHOR]

Introduction: A key concept for general practice nowadays is that of patient-centred medicine. In this model the physician's aim is to integrate the patient's experience of illness with the conventional understanding of disease, trying to reconcile the patient's agenda with his/her own. This paper describes a preliminary experience of a CME course on patient-centred medicine in Italy. Aim and Methods: The article focuses on a 7 hour course for teaching patient-centred medicine to Italian general practitioners. Assessment of the course was done both in terms of learner satisfaction and efficacy. Learner satisfaction was evaluated by a questionnaire with a 6-point Likert scale and course efficacy by a pre/post-paper-and-pencil test. Findings and Discussion: The pilot course on patient-centred medicine seems to obtain high satisfaction in participants. Furthermore, an increase in competence with regards to patient-centredness resulted after the course. The pilot study represents the first Italian CME seminar on patient-centred medicine. Results obtained both in terms of satisfaction and efficacy suggest that the CME course is a valid educational tool. The opportunity to extend the experience to a higher number of participants is therefore recommended. [ABSTRACT FROM AUTHOR]

Studies of health system responsiveness mostly focus on the demand side by investigating the association between sociodemographic characteristics of patients and their reported level of responsiveness. However, little is known about the influence of supply-side factors. This paper addresses that research gap by analysing the role of hospital-specialty characteristics in explaining variations in patients' evaluation of responsiveness from a sample of about 38,700 in-patients treated in public hospitals within the Italian Region of Emilia-Romagna. The analysis is carried out by adopting a 2-step procedure. First, we use patients' self-reported data to derive 5 measures of responsiveness at the hospital-specialty level. By estimating a generalised ordered probit model, we are able to correct for variations in individual reporting behaviour due to the health status of patients and their experience of being in pain. Second, we run cross-sectional regressions to investigate the association between patients' responsiveness and potential supply-side drivers, including waiting times, staff workload, the level of spending on non-clinical facilities, the level of spending on staff education and training, and the proportion of staff expenditure between nursing and administrative staff. Results suggest that responsiveness is to some extent influenced by the supply-side drivers considered., (Copyright © 2017 John Wiley & Sons, Ltd.)

Background: Involving doctors in management has been intended as one of the strategies to spread organizational principles in healthcare settings. However, professionals often resist taking on relevant managerial responsibility, and the question concerning by which means to engage doctors in management in a manner that best fit the challenges encountered by different health systems remains open to debate.Methods: This paper analyzes the different forms of medical management experienced over time in the Italian NHS, a relevant "lab" to study the evolution of the involvement of doctors in management, and provides a framework for disentangling different dimensions of medical management.Results: We show how new means to engage frontline professionals in management spread, without deliberate planning, as a consequence of the innovations in service provision that are introduced to respond to the changes in the healthcare sector.Conclusions: This trend is promising because such means of performing medical management appear to be more easily compatible with professional logics; therefore, this could facilitate the engagement of a large proportion of professionals rather than the currently limited number of doctors who are "forced" or willing to take formal management roles. [ABSTRACT FROM AUTHOR]

How do we display the uncanny? During the Second World War the medical school of Queen's University (Canada) commissioned artist Marjorie Winslow to make a series of wax teaching models to illustrate childbirth, in three dimensions, for the benefit of medical students. How have curators displayed these obstetric waxworks, which provoke strong feelings of disgust or of horrified empathy? Even in storage in the Museum of Health Care at Kingston, the Winslow waxworks remain concealed behind a curtain, and when they are on display, they are now far more likely to be part of an art exhibition than a medical history display. This paper uses the early history of obstetric waxworks and their display in eighteenth-century Italy to show how medical waxworks have always challenged the disciplinary divide between art and science. This historical context informs our understanding of the display history of the Winslow waxworks and of uncanny objects in general. [ABSTRACT FROM AUTHOR]

According to the common view held by the general public, doctors can never make professional mistakes, as if by virtue of their profession they were bound to be infallible. Moreover, when mistakes do occur in the medical field they are seen in a personal light, being attributed to an individual professional figure who is expected to answer for them in both the penal and the civil field. In this paper, the authors made a retrospective analysis of 37 of all the 725 legal suits filed in some hospitals of the Apulian region (South Italy) during the period between 1991 and 2000, being all those lodged against operators in the neurological, urological, otorhino-laryngoiatric and cardiosurgical fields, recorded in the Archives of the Health Services of Bari, Brindisi, Lecce and Taranto or in those of our Forensic Department following consultations on medical and surgical responsibility.

This paper describes preliminary experience in shared clinical management of patients located in Pointe Noire, Africa, and a referral center, Sacco University Hospital, located in Milan, Italy. The employed infrastructure INteractive TeleConsultation Network for Worldwide HealthcAre Services (INCAS) jointly developed by CEFRIEL (Center of Excellence For Research, Innovation, Education & Industrial Labs partnership) and ENI (Ente Nazionale Idrocarburi) is based on commercial off-the-shelf technology. This minimizes maintenance problems, while permitting a simple and friendly sharing of data using the telephone and e-mail for store-and-forward applications. The critical aspect of the flow of events comprising the exchange of information is discussed. In 60% of cases, only one telemedicine consultation was required. In the remainder 40%, a number of telemedicine consultations were required for appropriate management of clinical cases. The project demonstrated flexibility as documented by the wide range of pathologies that can be dealt with it. Finally the possibility of using shared clinical management as a learning tool is highlighted by the steep and rising learning curve. We conclude, however, that the patient, although handled in a "virtual" manner, should be viewed as very "real," as some of them elected to close the gap physically between Pointe Noire and Milan, and chose to be treated at the referral site.

Batrachochytrium dendrobatidis is considered a main driver of the worldwide declines and extinctions of amphibian populations. Nonetheless, fundamental questions about its epidemiology, including whether it acts mainly as a “lone killer” or in conjunction with other factors, remain largely open. In this paper we analysed contemporary and historical samples of the endangered Apennine yellow-bellied toad (Bombina pachypus) along the Italian peninsula, in order to assess the presence of the pathogen and its spreading dynamics. Once common throughout its range, B. pachypus started to decline after the mid-1990s in the northern and central regions, whereas no declines have been observed so far in the southern region. We show that Batrachochytrium dendrobatidis is currently widespread along the entire peninsula, and that this was already so at least as early as the late 1970s, that is, well before the beginning of the observed declines. This temporal mismatch between pathogen occurrence and host decline, as well as the spatial pattern of the declines, suggests that the pathogen has not acted as a “lone killer”, but in conjunction with other factors. Among the potentially interacting factors, we identified two as the most probable, genetic diversity of host populations and recent climate changes. We discuss the plausibility of this scenario and its implications on the conservation of B. pachypus populations. [ABSTRACT FROM AUTHOR]

Introduction: Malnutrition is a clinical condition due to the imbalance among needs, intake and use of nutrients, leading to the increase of morbidity and mortality, and to the impairment of quality of life. Even in industrialized countries undernutrition is becoming an alarming phenomenon, especially involving elderly institutionalized subjects. A multicentric study called PIMAI (Project Iatrogenic MAlnutrition in Italy), was carried out in Italy over 2005. The aims of this study were to determine the prevalence of malnutrition in hospitals and in nursing care homes (NH), to assess the level of nutritional attention and to measure the perceived quality in food and nutritional care. This paper represents a preliminary analysis of data collected in a NH included in the PIMAI project. Materials and methods: A total of 100 subjects (29 males and 71 females, aged 80.2±10 years), were recruited from January to June 2005 at the Clinical Rehabilitation Institute “Villa delle Querce” in Nemi (Rome), among patients in the NH facility. All the participants underwent a multidimensional geriatric evaluation (considering nutritional, clinical, functional and cognitive parameters), and a survey on “perceived quality” of nutritional care. Results and discussion: According to nutritional status defined by the Mini Nutritional Assessment®, data analysis showed a high prevalence of malnutrition (36%) especially related to advanced age, chewing, cognitive and functional impairments. Patients seemed to consider nutrition to be important for their health; on the other hand, they were not thoroughly satisfied with the quality of food. Particularly, it was observed scarce attention to nutritional status from medical and nursing staff. Conclusions: Our study confirms the need to pay greater attention to nutritional status in elderly institutionalized subjects. Medical and nursing teams need to be aware of the importance to perform an evaluation of nutritional status in these subset of subjects. [ABSTRACT FROM AUTHOR]

The object of this paper is to provide an opinion on the regulation of conscience clause in relation to doctors, nurses and pharmacists under Italian law. The opinion was based on the legislative texts available on the websites of the Italian government and the Ministry of Health. Conscience clause is governed by Article 9 of Legge 22 maggio 1978, Norme per la tutela sociale della maternità e sull'interruzione volontaria della gravidanza (Legge/194/1978), under which a doctor or nurse may refuse to provide and participate in carrying out abortions, should they submit a statement -- subject to Article 5(3). Conscience clause is governed by Article 16 of Legge 19 febbraio 2004, n.40 standard in materia di procreazione medicalmente assistita (Law 40/2004), under which a doctor or nurse may refuse to participate in medical procedures and assisted conception treatments. [ABSTRACT FROM AUTHOR]

In this paper I describe the context and goals of Francisco Vallés In IV librum Meteorologicorum commentaria (1558). Vallés' work stands as a landmark because it interprets a work of Aristotle's natural philosophy specifically for medical doctors and medical theory. Vallés' commentary is representative of new understandings of Galenic-Hippocratic medicine that emerged as a result of expanding textual knowledge. These approaches are evident in a number of sixteenth-century commentaries on Meteorologica IV; in particular the works of Pietro Pomponazzi, Lodovico Boccadiferro, Jacob Schegk, and Francesco Vimercati. Vallés' conviction that Meteorologica IV is relevant to medical knowledge depends on his understanding of Aristotle's theory of homeomerous substances and their relation to composite substances. The application of Meteorologica IV to medical topics became commonplace in the following years, and this Aristotelian book became widely known as a bridge between natural philosophy and medicine.

The Giornale de' letterati published in Rome from 1668 to 1681 was the first Italian scientific journal. It was meant to be the Italian version of the French Journal des Sçavans or the English Philosophical Transactions. Unlike these two, it was not backed by a formal or informal scientific institution, even if one of its editors, Giovanni Giustino Ciampini, was the founder of the Accademia Fisico-Matematica, the leading scientific academy in Rome in the second half of the XVIIth century. The paper, a preliminary step in a study on the diffusion and communication of European medical culture in Rome in this period, indexes and broadly examines the articles pertaining to medicine published in the journal.

Objective: To assess the impact of specialization on processes and outcomes of care for cancer patients., Data Source: Papers published in English between 1980 and 1995 and identified through MEDLINE and Embase (MeSH terms: NEOPLASM (exploded), and PHYSICIAN PRACTICE PATTERNS (or DECISION MAKING, ATTITUDE OF HEALTH PERSONNEL, QUALITY OF HEALTH CARE, DELIVERY OF HEALTH CARE, HEALTH EDUCATION or OUTCOME ASSESSMENT HEALTH CARE), or through the reference lists of review articles., Study Selection: Studies providing information on the association between quality of care indicators for cancer patients and clinician/centre degree of specialization. A total of 47 papers concerning 46 empirical studies were considered., Data Extraction: For studies using process of care indicators, the proportion of specific procedures performed by specialists and non-specialists was abstracted. For studies using outcome indicators (e.g., mortality), the effect of specialization was quantified in terms of odds ratio (OR) expressing relative reduction in risk of death. The quality of individual studies using process or outcome indicators was assessed according to study design, avoidance of selection bias in patient identification and data analysis, degree of adjustment of the comparison between clinicians/centres with different levels of specialization., Data Synthesis: Specialized centres/clinicians fared better both when process and outcome indicators were used. While the former varied widely in different studies and their clinical relevance was often questionable, mortality was consistently lower when care was provided by specialized centres/clinicians, with the effect size being greater in smaller studies. For breast cancer, where all the studies were of sufficiently good quality, a pooled estimate of the effect of specialization was performed which showed that specialized cancer care was associated with an 18% (95% CI: 12%-23%) reduction in mortality., Conclusions: Despite the fact that care provided by specialized centres/clinicians appeared to be better both when assessed in relation to process indicators and to mortality, this evidence should be considered far from conclusive because of major methodological flaws in these studies. Relative to current efforts to promote evidence-based policy-making, this review underscores the limited capability of scientific information to provide reliable guidelines for structuring better health care systems.

This paper offers a general review about the Spanish-Italian medical relations during the Renaissance. Spanish physicians travelled very often to Italy during this time, in order to get a better knowledge of the news advances in medicine. Many of them later occupied academic positions in Spanish universities and wide-spread the new ideas learned in Italy. The role played by printed books and manuscripts in their mutual relationships is here reported.

The University of Iowa Institute of Agricultural Medicine (IAM) played a significant role in the development of the field of agricultural medicine. This article is an excerpt from the electronic book The Institute of Agricultural Medicine: an Iowa Idea – Worldwide Impact, 2021 () which provides a detailed history of this story. Olaus Magnus (a clergyman in the Christian Church) in Sweden in 1555, and Bernardon Ramazzini (a physician) in Italy in 1713 wrote of health conditions in farmers. However, there is no evidence found (in the Western Hemisphere) before 1955, where a specific institute was present for the preventive health and medicine for farmers, their families, and their workers. There was an absence of research and outreach in the medical and public health fields in agricultural medicine. The history of the Institute of Agricultural Medicine (IAM) provides a substantive grounding for the field as it stands today. Further, the institute serves as something of a precursor of the One Health Initiative. Here, we trace the history of the institute and highlight its contributions to today's field of agricultural medicine. [ABSTRACT FROM AUTHOR]

Abstract: The paper deals with a survey on major advances in the field of bio-imaging presented at the WWMR2010 Conference, held in Florence (Italy) from 4th to 9th July 2010. The selected contributions have been organized into the following headings: Hyperpolarization, Acquisition Methods and Molecular Imaging applications. Overall, the Conference has witnessed an outstanding progress in either methods and applications that further stresses the key-role of MRI in many fields of biomedicine. [Copyright &y& Elsevier]

Nowadays, the frequency of children identified as being biologically fathered by someone other than the man who believes he is the father is such that, in the field of genetic counselling, it is likely to encounter cases of false paternity. The false paternity information, neither requested nor expected by the families in many cases, seems to regard only the "father" of the family but has repercussions for the entire family. By now, it has been accepted that genetic information is, by its nature, both individual and familial. The ethical-deontological debate centres on whether or not to inform the family about the necessity of a paternity test during the counselling and the counsellor's duty to reveal the results. In this paper, we analyse the Italian legislation on medical professionals' position concerning the doctor's role in genetics counselling; recent Sentences by Italian Courts and The Italian Personal Data Protection Code have underlined that the councellor has to give complete information to the people involved, also regarding the possibility to disclose a false paternity, to enable both parents to choose whether they want to know the truth. Because of these statements, it seems that in genetic counselling the respect for the "client's autonomy" is today prevalent in Italy, not only from an ethicaldeontological point of view, but above all, from a legal one. [ABSTRACT FROM AUTHOR]

This paper investigates how clinicians perceive managerial budgeting and how this affects clinical practice. To this end, case-studies were conducted involving two Italian public hospitals. The results show that clinicians' commitment to organizational objectives was strongly enhanced by the use of the budget as a means to evaluate and reward clinicians' performance. One of the main lessons learned from this study is that aligning existing institutions to organizational objectives is the only way forward for effective reform implementation. Consequently, the challenge for future reforms is to deal with the search of balance between efficiency goals and existing institutions. [ABSTRACT FROM AUTHOR]

To contribute to our understanding of the relationship between philosophical ideas and medical and healthcare models. A diachronic analysis is put in place in order to evaluate, from an innovative perspective, the influence over the centuries on medical and healthcare models of two philosophical concepts, particularly relevant for health: how Man perceives his identity and how he relates to Nature. Five epochs are identified-the Archaic Age, Classical Antiquity, the Middle Ages, the Modern Age, the 'Postmodern' Era-which can be seen, à la Foucault, as 'fragments between philosophical fractures'. From a historical background perspective, up to the early 1900s progress in medical and healthcare models has moved on a par with the evolution of philosophical debate. Following the Second World War, the Health Service started a series of reforms, provoked by anti-positivistic philosophical transformations. The three main reforms carried out however failed and the medical establishment remained anchored to a mechanical, reductionist approach, perfectly in line with the bureaucratic stance of the administrators. In this context, future scenarios are delineated and an anthropo-ecological model is proposed to re-align philosophy, medicine and health care. [ABSTRACT FROM AUTHOR]

Many Italian physicians embraced Protestant ideas during the sixteenth Century: this suggests a connection between medical science and religious nonconformity. But why were physicians so exposed to the influence of Protestantism? Can we suppose that their heretical views affected the way in which they conceived medicine? And can we posit a particular link between certain kinds of medical thinking and specific religious doctrines? In order to analyse this relationship, I will focus on a specific character: Girolamo Donzellini. As a physician of great renown, put on trial five times by the Venetian Inquisition and eventually sentenced to death, Donzellini is a good case study. Moreover, his exposure to the works of Paracelsus allows one to put forward some considerations on Italian Paracelsianism, showing that medical attitudes often described as incompatible by historians could actually coexist in the same person, as a result of the complexity of the cultural and religious context. [ABSTRACT FROM AUTHOR]

The Human Papillomavirus (HPV) is a sexually transmitted virus that causes cervical cancer. Since 2008 a vaccination program targeting 12-year-old girls has been initiated in Italy, backing up the cervical screening program already active since 1996. We propose a mathematical model of HPV transmission dynamics with the aim of evaluating the impact of these prevention strategies. The model considers heterosexual transmission of HPV types 16 and 18, structured by sex, age and sexual activity level, where transition to sexual activity is explicitly modeled from recent survey data. The epidemiological structure is a hybrid SIS/SIR, where a fraction of individuals recovering from infection develops permanent immunity against reinfection. Infections may progress to cervical lesions and cancer and heal spontaneously or upon treatment. Women undergoing hysterectomy (either after treatment of HPV lesions or by other causes) also transmit HPV infection. The model fits well both the age-specific prevalence of HPV infections and the incidence of cervical cancers in Italy, and accurately reproduces the decreasing trend in cancer incidence due to the introduction of the screening program. The model predicts that if the screening coverage is maintained at current levels, even in the absence of vaccination, such trend will continue in the next few decades, eventually plateauing at 25% below the current level. The additional initiation of routine vaccination targeting 12-year-old girls will further reduce cervical cancer incidence by two thirds at equilibrium, under realistic assumptions of 70% coverage and a duration of protective immunity of 50 years. If catch-up immunization of 25-year-old women at first cervical screening is also introduced, about 3,000 cervical cancer cases overall can be averted, corresponding to 9.6% of all cases expected in the scenario without catch-up. We conclude that HPV vaccination in addition to cervical screening will significantly reduce the burden of cervical cancer in Italy. [ABSTRACT FROM AUTHOR]

In this study, the neural mechanism subserving the ability to understand people’s emotional and mental states by observing their body language (facial expression, body posture and mimics) was investigated in healthy volunteers. ERPs were recorded in 30 Italian University students while they evaluated 280 pictures of highly ecological displays of emotional body language that were acted out by 8 male and female Italian actors. Pictures were briefly flashed and preceded by short verbal descriptions (e.g., “What a bore!”) that were incongruent half of the time (e.g., a picture of a very attentive and concentrated person shown after the previous example verbal description). ERP data and source reconstruction indicated that the first recognition of incongruent body language occurred 300 ms post-stimulus. swLORETA performed on the N400 identified the strongest generators of this effect in the right rectal gyrus (BA11) of the ventromedial orbitofrontal cortex, the bilateral uncus (limbic system) and the cingulate cortex, the cortical areas devoted to face and body processing (STS, FFA EBA) and the premotor cortex (BA6), which is involved in action understanding. These results indicate that face and body mimics undergo a prioritized processing that is mostly represented in the affective brain and is rapidly compared with verbal information. This process is likely able to regulate social interactions by providing on-line information about the sincerity and trustfulness of others. [ABSTRACT FROM AUTHOR]

We report the genetic characterization of 15 Klebsiella pneumoniae (KP) and 4 isolates of K. oxytoca (KO) from clinical cases in dogs and cats and showing extended-spectrum cephalosporin (ESC) resistance. Extended spectrum beta-lactamase (ESBL) and AmpC genes, plasmid-mediated quinolone resistance (PMQR) and co-resistances were investigated. Among KP isolates, ST101 clone was predominant (8/15, 53%), followed by ST15 (4/15, 27%). ST11 and ST340, belonging to Clonal Complex (CC)11, were detected in 2012 (3/15, 20%). MLST on KP isolates corresponded well with PFGE results, with 11 different PFGE patterns observed, including two clusters of two (ST340) and four (ST101) indistinguishable isolates, respectively. All isolates harbored at least one ESBL or AmpC gene, all carried on transferable plasmids (IncR, IncFII, IncI1, IncN), and 16/19 were positive for PMQR genes (qnr family or aac(6′)-Ib-cr). The most frequent ESBL was CTX-M-15 (11/19, 58%), detected in all KP ST101, in one KP ST15 and in both KP ST340. blaCTX-M-15 was carried on IncR plasmids in all but one KP isolate. All KP ST15 isolates harbored different ESC resistance genes and different plasmids, and presented the non-transferable blaSHV-28 gene, in association with blaCTX-M-15, blaCTX-M-1 (on IncR, or on IncN), blaSHV-2a (on IncR) or blaCMY-2 genes (on IncI1). KO isolates were positive for blaCTX-M-9 gene (on IncHI2), or for the blaSHV-12 and blaDHA-1 genes (on IncL/M). They were all positive for qnr genes, and one also for the aac(6′)-Ib-cr gene. All Klebsiella isolates showed multiresistance towards aminoglycosides, sulfonamides, tetracyclines, trimethoprim and amphenicols, mediated by strA/B, aadA2, aadB, ant (2")-Ia, aac(6′)-Ib, sul, tet, dfr and cat genes in various combinations. The emergence in pets of multidrug-resistant Klebsiella with ESBL, AmpC and PMQR determinants, poses further and serious challenges in companion animal therapy and raise concerns for possible bi-directional transmission between pets and humans, especially at household level. [ABSTRACT FROM AUTHOR]

Background: Methicillin resistant Staphylococcus aureus (MRSA) is a major etiological agent of infection in neonatal intensive care units (NICUs). Routes of entry of this organism can be different and the transmission pathway complex. Colonized neonates are the main endogenous reservoir. Methods and Results: We conducted a prospective three-year study on MRSA colonization recruiting 722 neonates admitted between 2009 and 2012. Nasal swabs were cultured weekly and MRSA isolates were submitted to molecular typing. The annual incidence density of acquisition of MRSA ranged from a maximum of 20.2 cases for 1000 patient-days during the first year to a minimum of 8.8 cases in the second one to raise again up to 13.1 cases during the third year. The mean weekly colonization pressure fluctuated from 19.1% in the first year to 13.4% in the second year and 16.8% in the third year. It significantly correlated with the number of MRSA acquisitions in the following week. Overall, 187 (25.9%) subjects tested positive for MRSA. A non multiresistant, tst positive, ST22-MRSA-IVa spa t223 strain proved to be endemic in the NICU, being identified in 166 (88.8%) out of 187 colonized neonates. Sporadic or epidemic occurrence of other strains was detected. Conclusions: An MRSA strain belonging to the tst1 positive, UK-EMRSA-15/ “Middle Eastern Variant” appeared to be endemic in the NICU under investigation. During the three-year period, substantial changes occurred in case-mix of patients moving towards a higher susceptibility to MRSA colonization. The infection control procedures were able to decrease the colonization rate from more than 40% to approximately 10%, except for an outbreak due to a CA-MRSA strain, ST1-MRSA-IVa, and a transient increase in the colonization prevalence rate coincident with a period of substantial overcrowding of the ward. Active surveillance and molecular typing contributed to obtain a reliable picture of the MRSA dissemination in NICU. [ABSTRACT FROM AUTHOR]

Objective: To analyze hospitalization for lower extremity amputations (LEAs) and amputee rates in persons with and without diabetes in Italy. Research Design and Methods: All patients with LEAs in the period 2001–2010 were identified analyzing the National Hospital Discharge Record database. For each year, amputee and hospitalization rates for LEAs were calculated either for persons with diabetes or without. Time trend for major and minor amputations were analysed. Results: From 2001 to 2010 a mean annual number of 11,639 individuals underwent a lower extremity amputation: 58.6% had diabetes accounting for 60.7% of total hospitalizations. In 2010, the crude amputee rate for LEAs was 20.4 per 100,000 inhabitants: 247.2 for 100.000 persons with diabetes, and 8.6 for those without diabetes. Having diabetes was associated to an increased risk of amputation (Poisson estimated RR 10.9, 95%CI 9.4–12.8). Over the whole period, a progressive reduction of amputee rates was observed for major amputations either among persons with diabetes (−30.7%) or without diabetes (−12.5%), while the rates of minor amputations increased progressively (+22.4%) among people without diabetes and were nearly stable in people with diabetes (−4.6%). A greater number of minor amputations were performed among persons with than without diabetes: in 2010, the minor-to-major ratio among persons with diabetes (2.5) was more than twice than in those without diabetes (1.0). Conclusions: The nationwide analyses confirm a progressive reduction of hospitalization and amputee rates for major LEAs, suggesting an earlier and more diffuse approach aimed at limb salvage. [ABSTRACT FROM AUTHOR]

KRAS testing is relevant for the choice of the most appropriate first-line therapy of metastatic colorectal cancer (CRC). Strategies for preventing unequal access to the test should be implemented, but their relevance in the practice is related to economic sustainability. The study adopted the Delphi technique to reach a consensus on several topics. Issues related to execution of KRAS testing were identified by an expert’s board and proposed to 108 Italian oncologists and pathologists through two subsequent questionnaires. The emerging proposal was evaluated by decision analyses models employed by technology assessment agencies in order to assess cost-effectiveness. Alternative therapeutic strategies included most commonly used chemotherapy regimens alone or in combination with cetuximab or bevacizumab. The survey indicated that time interval for obtaining KRAS test should not exceed 15 days, 10 days being an optimal interval. To assure the access to proper treatment, a useful strategy should be to anticipate the test after radical resection in patients at high risk of relapse. Early KRAS testing in high risk CRC patients generates incremental cost-effectiveness ratios between 6,000 and 13,000 Euro per quality adjusted life year (QALY) gained. In extensive sensitivity analyses ICER’s were always below 15,000 Euro per QALY gained, far within the threshold of 60,000 Euro/QALY gained accepted by regulatory institutions in Italy. In metastatic CRC a time interval higher than 15 days for result of KRAS testing limits access to therapeutic choices. Anticipating KRAS testing before the onset of metastatic disease in patients at high risk does not affect the sustainability and cost-effectiveness profile of cetuximab in first-line mCRC. Early KRAS testing may prevent this inequality in high-risk patients, whether they develop metastases, and is a cost-effective strategy. Based on these results, present joined recommendations of Italian societies of Oncology and Pathology should be updated including early KRAS testing. [ABSTRACT FROM AUTHOR]

Background: Recent studies have reported declines in incidence, prevalence and mortality for abdominal aortic aneurysms (AAAs) in various countries, but evidence from Mediterranean countries is lacking. The aim of this study is to examine the trend of hospitalization and post-operative mortality rates for AAAs in Italy during the period 2000–2011, taking into account the introduction of endovascular aneurysm repair (EVAR) in 1990s. Methods: This retrospective cohort study was carried out in Emilia-Romagna, an Italian region with 4.5 million inhabitants. A total of 19,673 patients hospitalized for AAAs between 2000 and 2011, were identified from the hospital discharge records (HDR) database. Hospitalization rates, percentage of OSR and EVAR and 30-day mortality rates were calculated for unruptured (uAAAs) and ruptured AAAs (rAAAs). Results: Adjusted hospitalization rates decreased on average by 2.9% per year for uAAAs and 3.2% for rAAAs (p<0.001). The temporal trend of 30-day mortality rates remained stable for both groups. The percentage of EVAR for uAAAs increased significantly from 2006 to 2011 (42.7 versus 60.9% respectively, mean change of 3.9% per year, p<0.001). No significant difference in mortality was found between OSR and EVAR for uAAAs and rAAAs. Conclusions: The incidence and trend of hospitalization rates for rAAAs and uAAAs decreased significantly in the last decade, while 30-day mortality rates in operated patients remained stable. OSR continued to be the most common surgery in rAAAs, although the gap between OSR and EVAR recently declined. The EVAR technique became the preferred surgery for uAAAs since 2008. [ABSTRACT FROM AUTHOR]

Background: The relationship between hospital volumes and short-term patients’ outcomes of colon cancer (CC) surgery is not well established in the literature. Moreover, evidence about short-term outcomes of urgent compared with elective CC procedures is scanty. The aims of this study are 1) to determine whether caseloads and other hospital characteristics are associated with short-term outcomes of CC surgery; 2) to compare the outcomes of urgent and elective CC surgery. Methods: A total of 14,200 patients undergoing CC surgery between 2005 and 2010 in the General Surgery Units (GSUs) of the hospitals of Emilia-Romagna region, Northern Italy, were identified from the hospital discharge records database. The outcomes of interest were 30-day in-hospital mortality, re-intervention and 30-day re-admission. Using multilevel analysis, we analyzed the relationship of GSU volumes and focused practice, defined as the percentage of CC operations over total operations, with the three outcomes. Results: High procedure volumes were associated with a lower risk of 30-day in-hospital mortality, after adjusting for patients’ characteristics [aOR (95% CI) = 0.51 (0.33–0.81)]. Stratified analyses for elective and urgent surgery showed that high volumes were associated with a lower 30-day mortality for elective patients [aOR (95% CI) = 0.35 (0.17–0.71)], but not for urgent patients [aOR (95% CI) = 0.72 (0.42–1.24)]. Focused practice was an independent predictor of re-intervention [aOR (95% CI) = 0.67 (0.47–0.97)] and re-admission [aRR (95% CI) = 0.88 (0.78–0.98)]. Conclusions: The present study adds evidence in support of the notion that patients with CC undergoing surgery at high-volume and focused surgical units experience better short-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that attitudes towards depression may be influenced by country-specific social and cultural factors. A survey was carried out to collect beliefs on and attitudes toward depression in Italy, which has an established community-based mental health system. Methods: A telephone survey was carried out in a probabilistic sample aged ≥15 years. A 20-item questionnaire was administered to explore knowledge of depression, stigma, causal beliefs, treatment preference, and help-seeking attitudes. Results: Of the 1001 participants, 98% were aware of depression, and 62% had experienced it, either directly or indirectly. A widespread belief (75%) was that people suffering from depression should avoid talking about their problem. A minority of the sample viewed depression as a condition that should be managed without recourse to external help or a “socially dangerous” illness. Among perceived causes of depression, most respondents mentioned life stressors or physical strains. Psychologists were often indicated as an adequate source of professional help. Half of the sample believed that depression should be pharmacologically treated, but drugs were often seen as addictive. Referring to a primary care physician (PCP) was considered embarrassing; furthermore, many people thought that PCPs are too busy to treat patients suffering from depression. Conclusions: Our findings indicate that depression is seen as a reaction to significant life events that should be overcome with the support of significant others or the help of health professionals (mainly psychologists). However, there are still barriers to the disclosure of depressive symptoms to PCPs, and concerns about the addictive effect of antidepressants. In the presence of a gap between people’s beliefs and what health professionals consider appropriate for the treatment of depression, a “shared decision making” approach to treatment selection should be adopted taking into account the patients’ preference for psychological interventions to ensure active compliance with effective treatments. [ABSTRACT FROM AUTHOR]

Background: We investigated temporal trends and geographic variations in both hospitalizations and in-hospital mortality rates for acute diabetic complications (ADC) in the Italian universal health care system. Methods and Findings: A retrospective review of the medical records of patients with either primary or secondary discharge diagnosis of hyperglycaemic acute complications (ICD-9-CM codes 250.1, 250.2, 250.3) or hypoglycemic coma (ICD-9-CM code 251.0) was performed in period 2001–2010. Standardized rates by age and gender on 2001 Italian population and by diabetic population were calculated. We identified 7,601.883 diabetes-related hospital discharges. Out of them, 266,374 (3.5%) were due to ADC, either ketoacidosis/hyperosmolarity (94.4%) or hypoglycemic coma (5.6%). The rate of discharge for ADC decreased by 51.1% from 2001 to 2010 (14.4 vs. 7.1 discharge rate/1,000 diabetic people; 5.7% decrease per year, test for trend, p<0.001) with a similar trend for both hyperglycemic and hypoglycemic complications. Diabetic people in the younger age groups (≤19 and 20–44 years old) had a significantly greater rate of discharge for ADC than people aged 65 years and over (≤19 10-fold increase; 20–44: 2-fold increase). In-hospital mortality rate was 7.6%, with 211 preventable deaths in younger diabetic people (≤44 years old). There was a large variability among Italian Regions and the ratio between the highest and the lowest regional discharge rate reached 300% in 2010. Conclusions: Decreasing temporal trend in hospitalizations for preventable ADC suggests improving outpatient care. In younger diabetic patients, however, both hospitalization rates and in-hospital mortality are still a matter of concern. [ABSTRACT FROM AUTHOR]

Background: The 18F-fluorodeoxyglucose (18F-FDG)-detected brown adipose tissue (BAT), is enhanced by cold stimulus and modulated by other factors that still have to be disentangled. We investigated the prevalence, mass, and glucose-uptake activity of 18F-FDG-detected BAT in a population of adults living in the temperate climatic zone of the Rome area. Methods and Findings: We retrospectively analyzed 6454 patients who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) examinations. We found 18F-FDG BAT in 217 of the 6454 patients (3.36%). Some of them underwent more than one scan and the positive scans were 278 among 8004 (3.47%). The prevalence of patients with at least one positive scan was lower in men (1.77%; 56 of 3161) compared with women (4.88%; 161 of 3293). The BAT positive patients were most frequently younger, thinner and with lower plasma glucose levels compared with BAT negative patients. The amount of BAT in the defined region of interest, the activity of BAT and the number of positive sites of active BAT were similar in both sexes. The prevalence of patients with 18F-FDG positive PET/CT was highest in December-February, lower in March-May and September-November, and lowest in June-August and was positively correlated with night length and negatively correlated with ambient temperature. Changes in day length and variations of temperature, associated with the prevalence of positive BAT patients. Among the patients who had multiple scans, outdoor temperature was significantly lower and day length was shorter on the occasion when BAT was detected. Conclusions: This study identifies day length, outdoor temperature, age, sex, BMI, and plasma glucose levels as major determinants of the prevalence, mass, and activity of 18F-FDG-detected BAT. [ABSTRACT FROM AUTHOR]

The incidence of type 1 diabetes has, progressively, increased worldwide over the last decades and also in Continental Italian population. Previous studies performed in northern European countries, showed, alongside a general increase in the disease incidence, a decreasing frequency of the highest risk HLA genotype in type 1 diabetes populations, thus emphasizing the role of environmental factors. The aim of the study was to evaluate whether a decreasing trend of high risk HLA, CTLA-4 and PTPN22 genotypes would be present in type 1 diabetes subjects of Continental Italy, a country considered at low incidence of the disease compared to northern European populations. N = 765 type 1 diabetes patients diagnosed from 1980 to 2012 in Lazio region were included. For HLA, CTLA4 and PTPN22 temporal trend evaluation, subjects were subdivided into groups of years according to age at diagnosis. All subjects were typed for HLA-DRB1 and DQB1 by a reverse line blot. The CT60 polymorphism of the CTLA4 and C1858T of the PTPN22 gene were genotyped using ABI PRISM 7900HT (n = 419 and n = 364 respectively). HLA genotypes were divided in high, moderate and low risk categories. The proportion of the HLA risk categories was not statistically different over the three decades in subjects with age of onset <15 years and ≥15 years. The genotype distribution of CT60 polymorphism of CTLA4 gene did not show any change in the frequencies during time. The analysis of the PTPN22 C1858T variant revealed, instead, that the frequency of CT+TT susceptibility genotypes decreased during time (23.9% vs 13.6%, p = 0.017). We can hypothesize that the pressure of the diabetogenic environment could be milder and therefore not sufficient to reduce the need of a strong genetic background (HLA) “to precipitate” diabetes; the increased pressure of the environment could have, instead, some effects on minor susceptibility genes in our population. [ABSTRACT FROM AUTHOR]

Objective: To assess decision-making in multiple sclerosis (MS) from third observer and patient perspectives. Method: Audio recordings of first-ever consultations with a participating physician (88 outpatients, 10 physicians) at four tertiary MS care clinics in Italy, were rated by a third observer using the Observing Patient Involvement in Shared Decision Making (OPTION) and by patients using the Perceived Involvement in Care Scale (PICS). Results: Mean patient age was 37.5, 66% were women, 72% had MS, and 28% had possible MS or other disease. Mean PICS subscale scores (range 0 poor, 100 best possible) were 71.9 (SD 24.3) for "physician facilitation" (PICS-F); 74.6 (SD 22.9) for "patient information exchange" (PICS-I); and only 22.5 (SD 16.2) for "patient decision making" (PICS-DM). Mean OPTION total score (0 poor, 100 best possible) was 29.6 (SD 10.3). Poorest OPTION scores were found for items assessing “preferred patient approach to receiving information” and “preferred patient level of involvement.” Highest scores were for “clinician drawing attention to identified problem”, “indicating need for decision making,” and “need to review the decision.” Consultation time, woman physician, patient-physician gender concordance and PICS-F were associated with higher OPTION total score; older physician and second opinion consultation were associated with lower OPTION score. Conclusions: In line with findings in other settings, our third observer findings indicated limited patient involvement abilities of MS physicians during first consultations. Patient perceptions of physician skills were better than third observers’, although they correlated. Consultations with women physicians, and younger physicians, were associated with higher third observer and patient-based scores. Our findings reveal a need to empower Italian MS physicians with better communication and shared decision-making skills, and show in particular that attention to MS patient preferences for reception of information and involvement in health decisions, need to be improved. [ABSTRACT FROM AUTHOR]

We performed a case-control study in 2,555 multiple sclerosis (MS) Sardinian patients and 1,365 healthy ethnically matched controls, analyzing the interactions between HLA-DRB1-DQB1 haplotypes and defining a rank of genotypes conferring a variable degree of risk to the disease. Four haplotypes were found to confer susceptibility (*13∶03-*03∶01 OR = 3.3, Pc 5.1×10−5, *04∶05-*03∶01 OR = 2.1, Pc 9.7×10−8, *15∶01-*06∶02 OR = 2.0, Pc = 9.1×10−3, *03∶01-*02∶01 OR = 1.7 Pc = 7.9×10−22) and protection (*11, OR = 0.8, Pc = 2.7×10−2, *16∶01-*05∶02 OR = 0.6, Pc = 4.8×10−16, *14∶01-4-*05∶031 = OR = 0.5, Pc = 9.8×10−4 and *15∶02-*06∶01 OR = 0.4, Pc = 5.1×10−4). The relative predispositional effect method confirms all the positively associated haplotypes and showed that also *08 and *04 haplotypes confers susceptibility, while the *11 was excluded as protective haplotype. Genotypic ORs highlighted two typologies of interaction between haplotypes: i) a neutral interaction, in which the global risk is coherent with the sum of the single haplotype risks; ii) a negative interaction, in which the genotypic OR observed is lower than the sum of the OR of the two haplotypes. The phylogenic tree of the MS-associated DRB1 alleles found in Sardinian patients revealed a cluster represented by *14∶01, *04∶05, *13∶03, *08∶01 and *03∶01 alleles. Sequence alignment analysis showed that amino acids near pocket P4 and pocket P9 differentiated protective from predisposing alleles under investigation. Furthermore, molecular dynamics simulation performed on alleles revealed that position 70 is crucial in binding of MBP 85–99 peptide. All together, these data suggest that propensity to MS observed in Sardinian population carried by the various HLA-DRB1-DQB1 molecules can be due to functional peculiarity in the antigen presentation mechanisms. [ABSTRACT FROM AUTHOR]

Sardinia is a major Island in the Mediterranean with a high incidence of multiple sclerosis, a chronic autoimmune inflammatory disease of the central nervous system. Disease susceptibility in Sardinian population has been associated with five alleles of major histocompatibility complex (MHC) class II DRB1 gene. We performed 120 ns of molecular dynamics simulation on one predisposing and one protective alleles, unbound and in complex with the two relevant peptides: Myelin Basic Protein and Epstein Barr Virus derived peptide. In particular we focused on the MHC peptide binding groove dynamics. The predisposing allele was found to form a stable complex with both the peptides, while the protective allele displayed stability only when bound with myelin peptide. The local flexibility of the MHC was probed dividing the binding groove into four compartments covering the well known peptide anchoring pockets. The predisposing allele in the first half cleft exhibits a narrower and more rigid groove conformation in the presence of myelin peptide. The protective allele shows a similar behavior, while in the second half cleft it displays a narrower and more flexible groove conformation in the presence of viral peptide. We further characterized these dynamical differences by evaluating H-bonds, hydrophobic and stacking interaction networks, finding striking similarities with super-type patterns emerging in other autoimmune diseases. The protective allele shows a defined preferential binding to myelin peptide, as confirmed by binding free energy calculations. All together, we believe the presented molecular analysis could help to design experimental assays, supports the molecular mimicry hypothesis and suggests that propensity to multiple sclerosis in Sardinia could be partly linked to distinct peptide-MHC interaction and binding characteristics of the antigen presentation mechanism. [ABSTRACT FROM AUTHOR]

Objective: To estimate the lifetime cost utility of two antiretroviral regimens (once-daily atazanavir plus ritonavir [ATV+r] versus twice-daily lopinavir/ritonavir [LPV/r]) in Italian human immunodeficiency virus (HIV)-infected patients naïve to treatment. Design: With this observational retrospective study we collected the clinical data of a cohort of HIV-infected patients receiving first-line treatment with LPV/r or ATV+r. Methodology: A Markov microsimulation model including direct costs and health outcomes of first- and second-line highly active retroviral therapy was developed from a third-party (Italian National Healthcare Service) payer’s perspective. Health and monetary outcomes associated with the long-term use of ATV+r and LPV/r regimens were evaluated on the basis of eight health states, incidence of diarrhoea and hyperbilirubinemia, AIDS events, opportunistic infections, coronary heart disease events and, for the first time in an economic evaluation, chronic kidney disease (CKD) events. In order to account for possible deviations between real-life data and randomised controlled trial results, a second control arm (ATV+r 2) was created with differential transition probabilities taken from the literature. Results: The average survival was 24.061 years for patients receiving LPV/r, 24.081 and 24.084 for those receiving ATV+r 1 and 2 respectively. The mean quality-adjusted life-years (QALYs) were higher for the patients receiving LPV/r than those receiving ATV+r (13.322 vs. 13.060 and 13.261 for ATV+r 1 and 2). The cost-utility values were 15,310.56 for LPV/r, 15,902.99 and 15,524.85 for ATV+r 1 and 2. Conclusions: Using real-life data, the model produced significantly different results compared with other studies. With the innovative addition of an evaluation of CKD events, the model showed a cost-utility value advantage for twice-daily LPV/r over once-daily ATV+r, thus providing evidence for its continued use in the treatment of HIV. [ABSTRACT FROM AUTHOR]

Background: Pigs play a key epidemiologic role in the ecology of influenza A viruses (IAVs) emerging from animal hosts and transmitted to humans. Between 2008 and 2010, we investigated the health risk of occupational exposure to swine influenza viruses (SIVs) in Italy, during the emergence and spread of the 2009 H1N1 pandemic (H1N1pdm) virus. Methodology/Principal Findings: Serum samples from 123 swine workers (SWs) and 379 control subjects (Cs), not exposed to pig herds, were tested by haemagglutination inhibition (HI) assay against selected SIVs belonging to H1N1 (swH1N1), H1N2 (swH1N2) and H3N2 (swH3N2) subtypes circulating in the study area. Potential cross-reactivity between swine and human IAVs was evaluated by testing sera against recent, pandemic and seasonal, human influenza viruses (H1N1 and H3N2 antigenic subtypes). Samples tested against swH1N1 and H1N1pdm viruses were categorized into sera collected before (n. 84 SWs; n. 234 Cs) and after (n. 39 SWs; n. 145 Cs) the pandemic peak. HI-antibody titers ≥10 were considered positive. In both pre-pandemic and post-pandemic peak subperiods, SWs showed significantly higher swH1N1 seroprevalences when compared with Cs (52.4% vs. 4.7% and 59% vs. 9.7%, respectively). Comparable HI results were obtained against H1N1pdm antigen (58.3% vs. 7.7% and 59% vs. 31.7%, respectively). No differences were found between HI seroreactivity detected in SWs and Cs against swH1N2 (33.3% vs. 40.4%) and swH3N2 (51.2 vs. 55.4%) viruses. These findings indicate the occurrence of swH1N1 transmission from pigs to Italian SWs. Conclusion/Significance: A significant increase of H1N1pdm seroprevalences occurred in the post-pandemic peak subperiod in the Cs (p<0.001) whereas SWs showed no differences between the two subperiods, suggesting a possible occurrence of cross-protective immunity related to previous swH1N1 infections. These data underline the importance of risk assessment and occupational health surveillance activities aimed at early detection and control of SIVs with pandemic potential in humans. [ABSTRACT FROM AUTHOR]

We have conducted a pilot trial of a home telemonitoring system involving 60 adult patients with cystic fibrosis (CF) enrolled at four Italian CF centres. Thirty randomly selected patients received a home device to perform spirometry and to measure oxygen saturation. The data were transferred to a data centre which forwarded them to the patient's CF clinic. The telemonitoring system was evaluated using questionnaires completed by patients and their doctors. The doctors reported that telemonitoring was useful in monitoring their patients' health status and in decreasing the CF centre workload. The data transfer procedure posed no particular problems for the patients. The major difficulties reported by the patients were night-time saturimetry measurements, and in the first week of the study, data transmission to the data centre. The pilot trial was positive and therefore merits a larger study. [ABSTRACT FROM AUTHOR]

Background: Light is one of the most important factors in our interaction with the environment; it is indispensable to visual function and neuroendocrine regulation, and is essential to our emotional perception and evaluation of the environment. Previous studies have focussed on the effects of prolonged anomalous exposure to artificial light and, in the field of work-related illness. Studies have been carried out on shift-work personnel, who are obliged to experience alterations in the physiological alternation of day and night, with anomalous exposure to light stimuli in hours normally reserved for sleep. In order to identify any signs and symptoms of the so-called ill-lighting syndrome, we carried out a study on a sample of anaesthesiologists and nurses employed in the operating theatres and Intensive Care Departments of three Italian hospitals. We measured the subjective emotional discomfort (stress) experienced by these subjects, and its correlation with environmental discomfort factors, in particular the level of lighting, in their workplace. Methods: We used a questionnaire developed by the Scandinavian teams who investigated Sick-Building Syndrome, that was self-administered on one day in the environments where the degree of illumination was measured according to UNIEN12464-1 regulations. Results: Upon comparison of the types of exposure with the horizontal luminance values (lux) measured (< 700 lux, between 1000-1500 lux, > 1500 lux) and the degree of stress reported, (Intensive Care: mean stress = 55.8%, high stress = 34.6%; Operating Theatres: mean stress = 51.5%, high stress = 33.8%), it can be observed that the percentage of high stress was reduced as the exposure to luminance was increased, although this finding was not statistically significant. Conclusion: We cannot share other authors' enthusiasm regarding the effects on workers well-being correlated to the use of fluorescent lighting. The stress level of our workers was found to be more heavily influenced by their familial and working conditions, irrespective of the ambient light stimulus. [ABSTRACT FROM AUTHOR]

In the 1790s, Luigi Galvani and Alessandro Volta were the main protagonists of a lively debate on the role of electricity in animal organisms. Significant developments originated from this debate, leading to the foundation of two new disciplines, electrodynamics and electrophysiology, that were to play a crucial role in the scientific and technological progress of the last two centuries. The Galvani-Volta controversy has been repeatedly reconstructed, sometimes in an attempt to identify the merits and the errors of one or the other of the two protagonists, sometimes with the aim of demonstrating that the theories elaborated by the two Italian scholars were irreconcilable, reflecting completely different ways of looking at phenomena and conceiving of scientific research. In this article a different interpretation is offered, based on a discussion of the scientific issues that were central to Galvani's and Volta's research, and with reference to the context of science and society of the eighteenth century. [ABSTRACT FROM AUTHOR]

The article reports on the 20th International Congress on Laser Medicine held in Florence, Italy November 10-12, 2005. The presentations focused on advances in laser applications. The participants were given the opportunity to interact with specialists in the field.

Despite a cultural and biomedical consensus about the health benefits of physical activity, most adults do not exercise regularly and their activity tends to decline further in older age. This study reports on a group of older-age Italian bicyclists who maintain extraordinary activity levels. It explores the physical and mental health effects of intensive exercise in older people, the meanings and motivations associated with it, and the cultural and social features that support and promote bicycling in Italy. The findings suggest some public health implications for the prevention of chronic diseases caused by inactivity and excessive body weight. [ABSTRACT FROM AUTHOR]

Presents an argument on the names of Alexandrian commentators, Akilaos and Anqilaos, in medical historiography. Information about Akilaos; Discussion on the society and language in Byzantine Northeastern Italy; Characterization of the population as Latin and Greek to the conceptions of ethnicity.

Most drugs used by children are prescribed by general pediatric practitioners (GPPs) in ambulatory settings. Prescription profiles are affected by GPPs' attitudes while the cost is related to the reimbursement modality. This study evaluated the Italian National Health Service (INHS) and family expenditures associated with prescribing practices to children younger than 12 years. Forty-two GPPs from southern Italy participated in the study.All visits recorded by GPPs during a 13-week period (February–April 1998), including telephone contacts and office and home visits were analyzed. The cost analysis of prescriptions is based on a sample of randomly selected consultations. INHS and family expenditures were evaluated according to reimbursement modalities for drug prescriptions. Total expenditure induced by all prescriptions during the study period was about 148 million Italian lire (7650 euros); 54% of this was borne by the INHS and the rest remaining by families. When corrections according to prescription modalities – following appropriate reimbursement form – were applied, only 49% of total expenditure were covered by INHS and 51% by families.Analysis of expenditures showed that drugs for symptomatic therapies (e.g., cough and cold preparations, analgesics, antipyretics) and vitamins accounted for most of the families' expenditure, while antibacterial and antiasthmatic drugs did so for the INHS.Of the ten most prescribed drugs the cost of three fell entirely on the family: paracetamol (the most commonly prescribed drug),morniflumate, and ambroxol. Therapeutic indications causing greatest expenditures for families were all the common,trivial childhood symptoms such as cough, fever, rhinitis, flu, and pharyngitis. Despite the universal coverage for pharmaceutical care more than onehalf of drug therapy expenditures for children was covered directly by the parents. Prescription attitudes by GPPs remain the crucial factor for an equal cost distribution between families and the INHS. [ABSTRACT FROM AUTHOR]

The article presents news and notices related to the medical field. It is reported that the 3rd International Symposium on Irritant Contact Dermatitis is to be held in Rome Italy during October 2-4, 1997. This Symposium will focus on recent clinical and experimental advances in the field of skin irritation. It is informed that Dermatopathology Self-assessment Workshop will take place on October 4, 1997 at the Cleveland Clinic Foundation.

The International Radio Medical Centre (CIRM) was founded in 1935, to provide free medical assistance by radio to ships with no doctor on board and others who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government. The results achieved by the Centre over 61 years include medical assistance to 42,935 patients on board ships (as well as on small islands and aircraft), with 375,264 medical messages received and transmitted. CIRM is organized into a medical service, a telecommunications service and a studies section. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case. If necessary the medical service will coordinate the patient's hospitalization at the nearest port with suitable medical facilities or arrange the patient's transfer to another ship with a doctor on board, or an airlift. The telecommunications service receives requests for assistance, locates the ship or whoever made the request, passes the call to the doctor on duty, and relays the doctor's response to those requesting assistance. The studies section, established in 1957-58, researches occupational pathologies of sailors and contributes to their prevention. This provides a scientific basis for improving medical assistance to sailors at sea. [ABSTRACT FROM AUTHOR]